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Social Anxiety, Depression And More...


Hi Dr. Schwartz,

I don’t want a diagnosis of any sorts. Rather, I want an opinion and some advice of some sorts. I have been diagnosed with depression and anxiety at a young age. When I was 14 I started showing symptoms of Social Anxiety and, although I’m not really sure if I’ve been diagnosed with it, I’m pretty sure I have it.

I have a very bad case of Phagophobia, fear of swallowing, that I think stemmed from social anxiety. And now I think I might be borderline as well, but that’s just a theory.

I am turning 21 this year and none of the above mentioned problems have gone away. My social anxiety got much better at some point but then it just took a dip again and now it’s just really bad again. To give you an example, I refuse to phone or answer phones. I avoid social situations at all costs. I’m too scared to go looking for a job because I don’t want to interact with people.

But the thing that actually really bothers me is my Phagophobia. Sometimes I’m fine, other times I’m not. It gets so bad to a point where I can’t even swallow my own saliva. It’s just terrible and I really don’t feel like spending the rest of my life living this way.

My question to you is, what is an effective way to get rid of these things? I’ve been on antidepressants but I stopped taking them because they weren’t working. I took them for about 2 years, I think. I saw a couple of psychologists but they just tumbled me around because I always ended up with a pregnant one that had to go on maternity leave after only a few sessions with them. And I don’t like talking. I hate talking. I tried hypnotherapy, but I only went for 2 sessions because my medical aid doesn’t pay for it. And that didn’t work. They told me to go back if it doesn’t work but I didn’t feel like wasting money on something that doesn’t work.

I’m considering seeing a psychologist again but, I know it’s not gonna go well because I don’t trust people and I don’t like talking. I’m also considering going back on anti depressants but only if it’ll help. Last time it made my anxiety much worse and it didn’t do much for my depression at all. Also, I can’t get myself to pick up the phone and just phone a psychologist. I just can not.

Some advice would really be appreciated because I’m not enjoying living at all.

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  • Dr. Schwartz responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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  • Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.

With regard to your swallowing difficulties, I recommend seeing your primary care physician just to rule out any possible medical problems. If it turns out that everything is negative in terms of your physical health, then it’s time to look at psychological issues. Indeed, in that case phagophobia, or fear of swallowing, would probably be the diagnosis.

Cognitive Behavioral Therapy(CBT) is an excellent choice when dealing with fears like the ones you are describing. Research shows that CBT is as effective as medication in treating depression and anxiety. Anti depressant medication could help, somewhat, but not without CBT. An additional benefit to CBT is that it does not rely, as much, on spontaneous talking and delving into the past. Rather, the method centers around modifying thinking and behavior so that fear responses are reduced an even eliminated in situations where they are not called for.

Cognitive Behavioral Therapy is also the preferred treatment for social anxiety because it, too, relies on modifying thinking and behavior in situations where there should be much less if it than you are experiencing. Gradually, you can be helped to engage in interactions with other people rather than avoiding them. The more you avoid, the more you will avoid. With CBT you can learn to reverse the process.

What you need to do is ask for a psychotherapist who specializes in doing CBT. Not all of them do, but, there are many who are available.

In addition to CBT, you could also go to our self help section here, at Mental Help Net and find the section on CBT and how to do it. Also, all of the deep relaxation  techniques, including Yoga, Meditation, Breathing exercises and Deep muscle relaxation, are all helpful in reducing the level of anxiety.

Best of Luck

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